MRSA nasal screening to rule out MRSA surgical site infection: a diagnostic meta-analysis

doi:10.3877/cma.j.issn.2096-0263.2020.03.009

Abstract

Abstract:

Objective

To evaluate the diagnostic value of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening in MRSA surgical site infection (SSI).

Methods

PubMed, EMBASE CNKI and WANFANG DATA were searched for studies evaluating MRSA nasal screening and development of MRSA SSI. The time of inclusion was from the establishment of the database to March 2019. Quality evaluation was carried out using QUADAS-2. Data analysis was performed using STATA software to estimate pooled sensitivity, specifcity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), positive predictive value (PPV), and negative predictive value (NPV).

Results

Ten studies, comprising 39 831 patients, met our inclusion criteria. The pooled sensitivity and specifcity of MRSA nares screen for MRSA SSI were 37% (95% CI: 27%, 48%) and 95% (95% CI: 94%, 96%), respectively. The PLR was 7.98 (95% CI: 6.37,10.0) and the NLR was 0.66 (95% CI: 0.57, 0.77). The PPV was 6.9%, the NPV was 99.3%, and DOR was 12.0 (95% CI: 8.62, 16.8). Heterogeneity arose from the methods used in MRSA screening (PCR/culture). Deeks funnel plot showed that the data and a low probability of publication bias.

Conclusions

Nares screening for MRSA had a high specificity and NPV for ruling out MRSA SSI. MRSA nares screening is a valuable tool to streamline empiric antibiotic therapy, especially among patients with SSI who are not colonized with MRSA.

Key words: Surgical site infection, Methicillin resistant staphylococcus aureus, Nasal screening, Meta-analysis

Pei Du, Jin Qin, Zhongjun Feng, Cuiying Zheng, Wei Gao, Peiyao Song, Yibing Liu. MRSA nasal screening to rule out MRSA surgical site infection: a diagnostic meta-analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(03): 171-177.

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References 26

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纳入文献	国家	年份	研究类型	年龄	样本量	TP	FP	FN	TN	SSI诊断标准	MRSA监测方法	MRSA监测时机
Kobayashi ^[14]	日本	2018	回顾性	45±24	132	1	4	9	118	CDC	细菌培养	门诊或术前
Torres ^[15]	美国	2016	回顾性	-	849	1	40	5	803	CDC	细菌培养	术前2周
Thakkar ^[16]	美国	2014	回顾性	59	519	2	23	3	491	CDC	细菌培养	术前4周
Saveli ^[17]	美国	2013	前瞻性	42±18	77	1	2	1	73	CDC	细菌培养	术中
Kalra ^[18]	美国	2013	回顾性	56	9006	8	379	19	8600	NHSN	PCR	门诊
Gupta ^[19]	美国	2011	回顾性	62	4238	3	276	6	3953	NHSN	PCR	术前4周
Parvez ^[20]	美国	2010	回顾性	54.8±24.1	5375	14	567	8	4786	NHSN	PCR	入院48小时内
Kim ^[21]	美国	2010	回顾性	-	7019	3	306	1	6709	CDC	PCR	-
Yano ^[22]	日本	2009	回顾性	60.5	2423	4	59	11	2349	CDC	细菌培养	门诊或入院时
Harbarth ^[13]	瑞士	2008	前瞻性	68±17	10193	29	486	41	9637	CDC	PCR	门诊或入院时

纳入文献	国家	年份	研究类型	年龄	样本量	TP	FP	FN	TN	SSI诊断标准	MRSA监测方法	MRSA监测时机
Kobayashi ^[14]	日本	2018	回顾性	45±24	132	1	4	9	118	CDC	细菌培养	门诊或术前
Torres ^[15]	美国	2016	回顾性	-	849	1	40	5	803	CDC	细菌培养	术前2周
Thakkar ^[16]	美国	2014	回顾性	59	519	2	23	3	491	CDC	细菌培养	术前4周
Saveli ^[17]	美国	2013	前瞻性	42±18	77	1	2	1	73	CDC	细菌培养	术中
Kalra ^[18]	美国	2013	回顾性	56	9006	8	379	19	8600	NHSN	PCR	门诊
Gupta ^[19]	美国	2011	回顾性	62	4238	3	276	6	3953	NHSN	PCR	术前4周
Parvez ^[20]	美国	2010	回顾性	54.8±24.1	5375	14	567	8	4786	NHSN	PCR	入院48小时内
Kim ^[21]	美国	2010	回顾性	-	7019	3	306	1	6709	CDC	PCR	-
Yano ^[22]	日本	2009	回顾性	60.5	2423	4	59	11	2349	CDC	细菌培养	门诊或入院时
Harbarth ^[13]	瑞士	2008	前瞻性	68±17	10193	29	486	41	9637	CDC	PCR	门诊或入院时

协变量		文献数量	灵敏度%（95% CI）	P值	特异度%（95% CI）	P值	双变量模型P值
研究类型
	前瞻性	2	39（17，61）	0.473	96（93，99）	<0.001	0.651
	回顾性	8	34（22，47）		95（94，97）
样本量
	<1000	4	22（3，40）	0.501	96（94，98）	<0.001	0.301
	≥1000	6	41（30，52）		95（93，97）
监测方法
	PCR法	5	44（33，55）	0.532	94（93，96）	<0.001	0.082
	普通培养法	5	25（10，40）		97（95，98）
监测时机
	入院时	5	36（23，49）	0.631	96（94，97）	<0.001	0.971
	其他	5	36（15，57）		95（93，97）

协变量		文献数量	灵敏度%（95% CI）	P值	特异度%（95% CI）	P值	双变量模型P值
研究类型
	前瞻性	2	39（17，61）	0.473	96（93，99）	<0.001	0.651
	回顾性	8	34（22，47）		95（94，97）
样本量
	<1000	4	22（3，40）	0.501	96（94，98）	<0.001	0.301
	≥1000	6	41（30，52）		95（93，97）
监测方法
	PCR法	5	44（33，55）	0.532	94（93，96）	<0.001	0.082
	普通培养法	5	25（10，40）		97（95，98）
监测时机
	入院时	5	36（23，49）	0.631	96（94，97）	<0.001	0.971
	其他	5	36（15，57）		95（93，97）

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